clEHR

clEHR is designed to alleviate the cognitive burden experienced by emergency department clinicians when retrieving and remembering patient data stored within Epic software during the initial evaluation process.

Scope

Product Design
Validation and Testing Plan

Client

Yale New Haven Hospital

Timeline

Jan. 2024 - Apr. 2024

My Role

User Researcher
Product Designer

THE CONTEXT

Despite the widespread adoption of Electronic Health Record (EHR) systems like Epic to improve healthcare efficiency, usability challenges have caused significant stress and burnout among clinicians, particularly in emergency departments. Recognizing these issues, physicians from Yale New Haven Hospital’s Emergency Department sought out our team to design user-friendly solutions that address their specific needs.

Yale-Initiating-Medication-for-Opioid-Use-Disorder-in-the-ED-667x400.jpg

PROBLEM

Emergency Department Workflow

The uniqueness of an EHR lies in its role as a tool to support clinicians' work rather than being an end in itself. Therefore, it is crucial to first understand emergency department professionals' current workflow. Within the process of diagnosing and treating patients, what specific goals must the EHR enable and support clinicians to achieve?

Through our interview with a Yale New Haven Hospital Emergency Department physician, we created a user flow journey that maps out their tasks and goals:

User Goal 1

Find the patient and associate with doctors

User Goal 2

Review most important patient data for evaluation, treatment, and test

User Goal 3

Order test

User Goal 4

Write notes

User Goal 5

Recheck vital signs

User Goal 6

Handoff

User Goal 7

Manage multiple patients simultaneously within a dynamic, non-linear workflow

Challenges with the current EPIC

Although the existing EPIC EHR meets the outlined goals most of the time, it often frustrates clinicians due to design shortcomings. This frustration arises from prioritizing comprehensive functionality and computerization over embedding intuitive medical logic at its core. Key issues include challenges in user experience, difficulties in information retrieval, and navigation complexities.

Discoverability Challenges

Key information is often buried, requiring significant time and effort to locate. In the ED, vital signs are critical for clinicians but are not prominently displayed. The interface is cluttered with irrelevant or "noise" data, making it difficult for users to focus on the essential information needed for timely decision-making.

Accessibility Issues

The system contains numerous items with duplicated or inconsistent patient history information, which complicates data interpretation. Furthermore, certain critical functions and pieces of data are either missing or inadequately supported within the EHR.

Information Orgnization

Clinicians struggle to access needed information easily due to a lack of intuitive design. The absence of a clear visual hierarchy results in a messy and disorganized presentation of data, making it difficult to quickly identify and act on what is important.

Click Fatigue

Excessive clicks are required to complete tasks, such as placing orders, making the process unnecessarily cumbersome. Additionally, the frequent appearance of pop-up boxes disrupts workflow and reduces overall efficiency.

Data Quality

Medication information in EHRs is often incomplete, outdated, or missing, especially if the pharmacy is external to the hospital system. Some medications may also appear as conflicting, duplicated, or unsynchronized with the patient's pharmacy. These issues stem from challenges such as data entry errors, lack of system interoperability, and insufficient data governance. Addressing this requires solutions beyond user experience—focusing on robust data structures, system interoperability, and database design.

User Painpoints

By synthesizing user feedback and conducting a heuristic evaluation, we gained valuable insights into the challenges users face, which contribute to frustration and burnout during their work processes.

Scope: Given the constraints of the project timeline, this phase will focus specifically on the workflow from post-triage to the initial evaluation.

#1 ED Track Board

The ED Track Board aims to help clinicians quickly identify high-priority patients but falls short due to its current design. Clinicians rely on nurse-assigned acuity levels (1-5), which lack sufficient differentiation, forcing time-consuming chart reviews to determine urgency. Additionally, much of the dashboard’s information is tailored for nurses, leaving clinicians without the critical data they need for efficient decision-making.

#2 Triage/ Chart reviews

During the initial evaluation, clinicians rely on the triage tab for patient information, but its cluttered layout and lack of visual hierarchy distract from critical details. Excessive junk data, duplicated and inconsistent history items, and missing or outdated medication information further hinder its usability.

After analyzing these challenges from ED professionals, it became clear that a comprehensive redesign of the EHR is essential. However, Epic's decades of development make significant UX changes technically and organizationally complex, as they require reworking embedded workflows while ensuring regulatory compliance. An alternative approach could involve building new software, such as clEHR, from the ground up to prioritize user needs and improve the experience. Additionally, Epic's interoperability allows for creating an integrated layer without replacing the existing system.

DESIGN GOALS

Make it clear and impactful

As a designer, the greatest challenge lies in organizing the vast amount of patient information to enable clinicians to make diagnostic, testing, and treatment decisions efficiently and effectively. The ultimate goal is to simplify the clinical electronic health record (clEHR) and make it more intuitive and accessible for every user.

Enable interoperability

System Design

The software system consists of three pieces of software:

(A) the patient dashboard user interface

(B) Epic’s HL7 API communication between our software and Epic,

The one external link is to the Epic EHR database, which is accessed through the Epic OAUTH Authentication Module. Subsystem A is subdivided into major modules as well.

DESIGN SOLUTIONS

ED Track Board

#1-1

The ED Track Board now provides emergency clinicians with essential information at a glance, including triage times, room duration, summaries, and vitals.
Clinicians can quickly access their assigned patients directly via the sidebar, ensuring streamlined navigation.
Additional functions for notes, orders, tests, and dispositions are easily accessible for efficient workflow management.

#1-2

The previous dashboard required extensive chart reviews to identify urgent cases due to minimal differentiation in acuity scores, with many patients labeled as 3 or 4. The new design offers clinicians a comprehensive view of patients' triage summaries, vitals, and history upfront, enabling them to prioritize and select patients more effectively.

#1-3

ED attendings typically manage 12-20 patients simultaneously, making centralized tracking crucial. The My Patients dashboard consolidates vital signs, timing, and test progress, enabling clinicians to efficiently monitor status and take action, such as initiating treatment or coordinating with specialists, after initial evaluations.

Before

After

Patient Profile

#2-1

ED clinicians require diverse information to make decisions, but EPIC's comprehensive data often presents irrelevant details, as some fields are rarely used. The new design addresses this by allowing clinicians to customize or search for the most relevant information.
Since patient care in the ED is non-linear and requires ongoing monitoring, the design focuses on displaying key information throughout the patient's journey.